What is Twilight Anasthesia?

[Jake7676]

Can some doctors explain to me what the term Twilight Anasthesia simply means?

Could it be used to perform Gynecomastia surgeries.

[Dr. Elliot Jacobs]

"Twilight" anesthesia is actually my preferred method of anesthesia for gyne surgery -- I use it about 98% of the time.  You could think of it as a half-way type of anesthesia between local anesthesia (in which the patient is totally awake) and general anesthesia, in which the patient is absolutely asleep (actually unconscious) with a tube in his throat and a machine breathing for him.

Twilight anesthesia combines the best of both of the above types of anesthesia, IMHO.  It must, however, be administered by an expert anesthesiologist.  His job is to keep the patient safe and sleeping gently while I concentrate on doing the operation.  It is an individualized combination of very short-acting medications, which are periodically administered by an IV line to keep the patient gently sleeping quietly.  The actual pain-killing medications are injected by the surgeon, such as is done in local anesthesia.  But the patient doesn't even feel the injections because he is asleep.  The result is a very pleasant, relaxed sleep while the surgery is done.  But since the drugs are very short acting, once the surgery is over, the patient awakens within a few minutes with no nausea, vomiting, hangover or grogginess (which frequently occurs with general anesthesia for up to 24 hrs after surgery). 

It does require close cooperation between the anesthesiologist and the surgeon, something that only occurs over time.  In my practice, I have worked with the same anesthesiologist for over 21 years, so we can almost read each other's minds when it comes to managing the patient.  The beauty is when I am putting my last stitch in place, the patient is awake and talking lucidly to me.  And of course, there is no pain because the local anesthetic will last for several hours more.  We can then put some bandages and a compression garment on the patient and he can literally walk to the recovery area.

For me, I believe it is the ideal form of anesthesia for my patients.

Dr Jacobs

[Litlriki]

I use general anesthesia for most of my patients, though during the first 8 years I was in practice, I used intravenous sedation rather than general anesthesia, as this was less expensive for the patients.  In my current practice situation, the cost is the same, and because I work in a hospital with anesthesia residents, I am certain that I'll have consistency with general anesthesia, whereas I'm not sure how "expert" the resident assigned to my cases will be to do a good "twilight sleep" approach.  I agree with Dr. Jacobs that such an approach works great, but it is very operator dependent, and the long-standing relationship between the surgeon and anesthesia staff is critical for that approach.

Rick Silverman

[DrPensler]

Twilight anesthesia refers to sedation during surgery via an iv where the patient is in the "twilight zone" but not intubated ( a tube down the throat and placed on a ventilator). Another term that is often used is conscious sedation.In my practice it is used routinely for gynecomastia correction.Typically agents with a short half life are used which leads to a fast recovery.
I perform gynecomastia under local anesthesia,twilight sedation and general anesthesia.Different patients have different needs and desires but the majority are under twilight..
From a surgical (my) standpoint ,the patient should be safe,comfortable and still.Surgery is tough but its tougher on a moving target.